Fractures occur at an earlier age among men with HIV

An interesting article from AIDSMap…

Michael Carter
Published: 13 June 2017

The incidence of fractures begins to rise a full decade earlier in HIV-positive men compared to their HIV-negative peers, investigators from the United States report in AIDS. Analysis by age group showed that fracture incidence among men in their 50s was double that observed in HIV-negative men in the same age range (the control group).

“A significant increase in fracture incidence was found among 50 – 59-year-old HIV + men, highlighting the importance of osteoporosis screening for HIV-infected men above the age of 50,” note the authors.

Bone problems such as osteopenia and osteoporosis are more common among HIV-positive men and women compared to their HIV-negative peers. Bone loss also occurs at a younger age in people with HIV. This means that people with HIV have a higher risk of fractures, with several studies showing that rates of all fractures and fragility fractures are elevated among HIV-positive individuals.

Possible risk factors for fracture risk in people with HIV include treatment with specific antiretroviral drugs (tenofovir and protease inhibitors) and co-infection with hepatitis C virus (HCV). Traditional risk factors such as ageing, smoking, body weight, alcohol use and co-morbidities also increase the risk of fractures.

There is still uncertainty concerning the age at which fracture risk screening should start for people with HIV.

Investigators from the ongoing MACS cohort study, therefore, designed a prospective, multi-centre study comparing fracture incidence among middle-aged and elderly HIV-positive and HIV-negative men. The authors hypothesised that HIV infection would increase the risk of fracture associated with ageing.

Self-reported fracture data were obtained from 1221 HIV-positive men and 1408 HIV-negative men.

The two groups were well matched for traditional risk factors associated with fracture, including age, BMI, kidney function and alcohol use. However, men with HIV were more likely to be non-white, have co-infection with HCV and be current smokers.

Median CD4 cell count among the HIV-positive individuals was 490 cells/mm3. Two-thirds were taking tenofovir with a median cumulative exposure of just over three years. Protease inhibitor use was reported by 44% of participants; median cumulative exposure was 4.5 years.

During approximately 34,000 person-years of follow-up, 379 men experienced fractures, an overall incidence of 11.2 fractures per 1000 person-years.

A total of 182 fractures occurred in men with HIV (incidence rate, 12.8 per 1000 person-years) and 197 in HIV-negative individuals (incidence rate, 10.0 per 1000 person-years).

When stratified according to age, fracture incidence among HIV-negative men was similar for those in their 40s and 50s, only increasing once individuals reached the age of 60.

However, for those with HIV, there was an increased incidence of fractures for men in their 50s as well as those aged 60 and over.

After adjusting for potential confounders, hypertension was the only risk factor significantly associated with an increased risk of all fractures (aIRR = 1.32; 95% CI, 1.04-1.69).

HIV significantly modified the effect of age on fracture risk (p = 0.002). There was a significant increase in the incidence of all fractures in HIV-negative men aged 60 and over (aIIR= 1.51; 95% CI, 1.06-2.16) and for HIV-positive men in their 50s (aIRR = 1.92; 95% CI, 1.41-2.61), as compared to HIV-negative men in their 40s.

In the analysis restricted to HIV-positive men, there was an increased incidence of fractures among men in their 50s compared to those in their 40s (aIRR = 1.66; 95% CI, 1.18-2.34). Antiretroviral therapy was associated with an increased risk of fractures (aIRR = 2.11; 95% CI, 1.22-3.63). Higher BMI was protective. Neither tenofovir nor protease inhibitor use was associated with a higher rate of all fractures.

A total of 140 fragility fractures occurred among 36,060 person-years. Incidence was higher in HIV-positive individuals compared to HIV-negative individuals (4.6 vs. 3.4 per 1000 person-years).

Analysis by age showed that HIV-negative men in their 40s and 50s had a similar incidence of fragility fractures (2.9 per 100 person-years), with incidence jumping among men aged 60 and over (5.1 per 1000 person-years).

Within the HIV-positive group, the incidence of fragility fractures increased from 2.6 per 1000 person-years among men in their 40s to 6.3 per 1000 person-years for those in their 50s and 7.6 per 1000 person-years for individuals aged 60 and older.

HIV-positive men in their 50s had double the fragility fracture risk of HIV-negative men in their 40s (aIRR = 2.11; 95% CI, 1.24-3.55).

Restricted analysis to the HIV-positive group showed that fragility fracture risk increased with age. Current HIV therapy increased the risk of fragility fracture, but this finding was only of marginal significance (aIRR = 2.54; 95% 0.97-6.61). Viral load was not associated with an increased risk of fragility fracture, nor were the cumulative use of tenofovir or protease inhibitors.

“We found that HIV + MACS participants had higher incidence of all fractures and fragility fractures compared with HIV – controls and that the rate of fracture was higher among HIV + men aged 50-59 years compared with HIV – participants of a similar age,” conclude the authors. They recommend that all HIV-positive men aged 50 years and older should have DXA scans to assess their bone health.

Reference

Gonciula A et al. An increased rate of fracture occurs a decade earlier in HIV + compared with HIV – men. AIDS 31: 1435-43, 2017.

Powerful new campaign puts HIV stigma centre stage!

The issue of stigma is never far away from the conversation and this powerful awareness campaign from QPP needs to be shared far and wide…we need to raise awareness and take part in the conversation to educate, inform and reduce stigma.
As a community we have the chance to really make change happen.  We need to work each day to build resilience and to support each other even when we are faced with stigma and discrimination.
Below is the link to the youtube video…enjoy and feel free to share it round.
Published on Jun 4, 2017

Real-life exchanges from mobile dating app Grindr are at the centre of a powerful new awareness campaign spotlighting HIV stigma and its effects on the LGBTI+ community.

AIDS Film “120 Beats Per Minute” Stands Out at Cannes 

Robin Campillo’s “vital new gay classic” follows the Paris chapter of ACT UP in the early 1990s.

May 23, 2017

Directed by Robin Campillo, the film—originally 120 Battements Par , in French, but also simply BPM—follows the Paris chapter of the AIDS activist group ACT UP in the early 1990s. Vanity Fair reviews the movie as “deeply effective,” characterizing it as “half sober and surveying docudrama, half wrenching personal illness narrative” and labeling the film a “vital new gay classic.”

Of the film, IndieWire said that although the film “never quite takes off into the emotional intensity suggested by the material, it nevertheless arrives at a powerful raison d’être, with layers of its ecosystem slowly assembling until a fully defined revolt reveals itself. The finale is a masterstroke of editing.”

In its own review, The Hollywood Reporter says the film’s style is more contemplative than that of Larry Kramer’s The Normal Heart and that “Campillo has a finely tuned ear for the volatile currents of group discussion. He also has a knack for seamlessly incorporating sociopolitical context into a dramatic canvas—evident in early scenes here when succinct references reveal that even after a decade of heavy losses, 6,000 new cases per year of HIV/AIDS were still being registered in France in the early ’90s, double the number of the U.K. or Germany.”

The Hollywood Reporter also offers an interview with the director, in which he explains, “I actually lived through this time. I was an ACT UP militant in the ’90s.”